India needs to show urgency on drug resistant TB

The growing number of drug-resistant tuberculosis (DR-TB) cases in India calls for greater urgency to solve major problems surrounding the treatment of TB and regulation of TB drugs in the country’s private market, the international medical humanitarian organization Médecins Sans Frontières / Doctors Without Borders (MSF) said here on Friday. It has called for revisiting the treatment protocols to make them simple so that patients adhere to it and regulating the sale of TB drugs in the private market.

India has the second highest DR-TB burden in the world with an estimated 99,000 new multi-drug-resistant (MDR) cases every year. Yet in 2010, only 2 per cent of the estimated cases received second-line drug treatment under the national programme, MSF said at a press conference on the eve of the World TB Day. The MSF views were shared by the Peoples’ Health Movement, Stop TB Partnership and Delhi Network of Positive People (DNP+).

“It is painfully clear that DR-TB infections are on the rise in India,” said Dr. Amit Sengupta from Jan Swasthya Abhiyan / The Peoples’ Health Movement. “The conditions for emergence of drug resistance are undeniably prevalent, in both the public programme and the private health sector.”

In India, the Revised National TB Control Program (RNTCP) provides treatment to TB patients on alternate days, instead of daily treatment. This poses a higher risk for patients to miss doses, which is another key factor that leads to the creation of drug-resistant strains of TB. Further, the programme does not invest in treatment counseling that strengthens adherence to treatment, he said.

“The Direct Observed Treatment (DOT) model implemented by RNTCP is paternalistic, and fails to empower and support patients through TB treatment serving up a perfect recipe for treatment interruptions. This has implications not only for the patients treated but also on the development of drug resistance,” said Hari Shankar of DNP+. “With treatment counseling, patients like me can easily adhere daily to fixed dose combinations of HIV medicines without having to be observed by health authorities every day. The TB programme should make treatment protocols that are simple to adhere to and are supported by treatment counseling, just as has been done for AIDS treatment.”

At MSF’s HIV clinic in Mumbai, HIV+ patients who reach the clinic often arrive in very bad condition and even die before their DR TB treatment can be started. Usually these patients have already been treated in the private sector with inappropriate TB drug regimens.

“The proliferation of TB formulations in the private market coupled with the casual over-the-counter sale of antibiotics, of which some are used for DR TB treatment, is fuelling the development of drug resistance,” said Piero Gandini, MSF’s Head of Mission in India. “There is an urgent need for regulatory control of sale and administration of TB drugs in the private sector in order to address the growing incidence of severe forms of DR-TB in India.”

“The world is watching India’s growing DR-TB crisis. Now that we have new tests that can detect DR-TB in less than two hours, it’s a perfect time for the government to take immediate action to boost access to diagnosis and treatment of DR TB in the public programme so that more people are started on appropriate drug regimens and we can reduce transmission of this disease in India,” said Blessina Kumar of the Stop TB Partnership.